Hidden Penis in Children: Evaluation of Outcomes and Review of the Literature

Background: There are many categories in hidden penises usually differentiation among the terms includes: concealed (before circumcision), trapped (cicatricial or scarred) after circumcision), and buried (associated with adolescence and obesity). Methods: From December 2014 to August 2015, we evaluated 10 patients (6 months–10 years old) with buried penises, concealed penises, trapped penises and webbed penises that were surgically. All the patients were scheduled for regular follow-up at 1, 4, and 12 weeks postoperatively. Results: l0 patients underwent surgical repair, all buried and concealed patients had penile degloving and penile fixation. All patients reported much improved urinary function, and all patients stated that they were pleased or very happy with their outcome Conclusions: Children with hidden penis are can be psychologically affected and have a risk for social trauma. The wide variety of approaches to correcting this problem reflects the different perceptions of etiology. Treatment for hidden penis should aim to restore an aesthetic and functional penis. *Corresponding author: Ruankha Bilommi, Department of Pediatric Urology, Mitra Keluarga Group General Hospital, YARSI Medical Faculty, Jakarta, Indonesia, Tel: 62 81312228237; E-mail: [email protected] Received October 29, 2015; Accepted December 15, 2015; Published December 20, 2015 Citation: Bilommi R (2015) Hidden Penis in Children: Evaluation of Outcomes and Review of the Literature. Med Surg Urol 4: 156. doi:10.4172/2168-9857.1000156 Copyright: © 2015 Bilommi R. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Keyword: Children; Hidden; Lymphedema; Penis Introduction When a penis appears absent or too small, we call the condition Hidden penis. There are many categories in hidden penises; buried penis, webbed penis, concealed penis, and trapped penis. Several classification systems have been proposed, although none has been universally adopted in the literature. Usually, differentiation among the terms includes: concealed (before circumcision), trapped (cicatricialor scarred) after circumcision), and buried (associated with adolescence and obesity) [1]. The buried penis is widely regarded as a condition which is difficult to manage both in children and in adults. Buried penis was first described by Keyes in 1919 as follows: “absence of the penis exists when the penis, lacking its proper sheath of skin, lies buried beneath the integument of the abdomen, thigh or scrotum” Buried penis in adults may have a congenital component in some cases but is largely regarded as being an acquired condition as a consequence of obesity [1-3]. Various etiologic factors have been proposed to explain congenital buried penis. Recent literature favors digenetic dartos tissue with abnormal attachments proximally and to the dorsal cavernosum. A prominent prepubic fat pad is also a common primary factor, in addition to digenetic dartos fascia. Secondary buried penis may be the result of an overzealous circumcision with subsequent cicatricial scar (trapped penis), a large hernia, or a hydrocele. Another possible cause of buried penis in the adult is genital lymphedema. This may be idiopathic, iatrogenic (from prior surgery), or acquired due to filariasis [1-4]. In children, presentation is often driven by parental concerns over urinary symptoms and penile size. The complex interaction of significant physical and psychological symptoms of patients with a buried penis means that treatment must be tailored to the individual. Indeed, within the literature, no single operative technique has been described to meet all patients’ needs. Algorithms have been advocated for treatment of adults with buried penis to take into account the different surgical approaches to this problem. Consideration for surgical reconstruction necessitates earnest discussion with the family regarding the potential functional, cosmetic and psychosocial outcome of surgical reconstruction [5,6]. Patients and Methods From December 2014 to August 2015, we evaluated 10 patients (6 months-10 years old) with buried penises, concealed penises, trapped penises and webbed penises that were went to surgery. There are ten cases; 2 had buried penises, 3 had concealed penises, 4 had trapped penises and 1 patient had webbed penis. All cases were evaluated clinically with emphasis on true length of the penis, the presence or absence of the prepuce, the length of penile skin in circumcised patients and presence of any inflammations or cicatrizing scars following circumcision Establishing the diagnosis of concealed penis and its category, as buried, webbed or trapped, can be done with clinical examination only. Great care was directed to preoperative penile hygiene especially in buried and trapped penis. Surgical technique general anesthesia with endotracheal intubation was given to all cases and local anesthesia was avoided as dissection of the surgical planes could then become more difficult. Buried Penis: Cases with buried penis were repaired using technique (t.A) of a traction suture was applied to the glans, a circumferential coronal incision was done, and by using the Buck’s fascia as the plane of dissection, the penis was degloved to the penopubic junction. Sharp dissection of the digenetic dartos fibers, to free the penis from its deep tethering, was carried out. Fixation was then performed by placement of absorbable sutures (polyglycolic acid Citation: Bilommi R (2015) Hidden Penis in Children: Evaluation of Outcomes and Review of the Literature. Med Surg Urol 4: 156. doi:10.4172/21689857.1000156